Amitai Y, Lovejoy F H
Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
J Toxicol Clin Toxicol. 1987;25(7):539-54. doi: 10.3109/15563658708992656.
Vomiting in acute theophylline toxicity has assumed increased clinical importance since the introduction of multiple dose activated charcoal therapy. We performed a prospective study of 26 patients with acute overdose of sustained release theophylline to characterize vomiting, and its possible interference with the acceptance of activated charcoal. Twenty five of 26 patients vomited. The duration of vomiting correlated with both peak serum theophylline concentrations (p less than 0.001) and the duration of theophylline toxicity (p less than 0.001). Vomiting extended over 63% of the drug's absorptive phase (the time interval between ingestion and the peak level) and 49% of the elimination phase (the time interval between the peak level and decrease of theophylline level to less than 20 mcg/ml). Patients with peak serum theophylline concentrations less than 70 mcg/ml were able to accept larger amounts of activated charcoal than patients with serum theophylline concentrations greater than 70 mcg/ml (113 +/- 15 gms vs. 57 +/- 24 gms, p less than 0.05). Vomiting in acute sustained release theophylline toxicity is protracted, and limits the use of activated charcoal especially in patients with severe acute theophylline poisoning.
自从采用多剂量活性炭疗法以来，急性茶碱中毒时的呕吐在临床上变得愈发重要。我们对26例急性过量服用缓释茶碱的患者进行了一项前瞻性研究，以描述呕吐情况及其对接受活性炭治疗可能产生的干扰。26例患者中有25例出现呕吐。呕吐持续时间与血清茶碱峰值浓度（p<0.001）及茶碱中毒持续时间（p<0.001）均相关。呕吐持续时间超过药物吸收期的63%（摄入至峰值浓度的时间间隔）和消除期的49%（峰值浓度至茶碱浓度降至<20 mcg/ml的时间间隔）。血清茶碱峰值浓度<70 mcg/ml的患者比血清茶碱浓度>70 mcg/ml的患者能够接受更多的活性炭（113±15克 vs. 57±24克，p<0.05）。急性缓释茶碱中毒时的呕吐持续时间长，限制了活性炭的使用，尤其是在严重急性茶碱中毒患者中。
